# Effect of Variable Priority Cognitive-Motor Dual-Task Training on Cognitive and Physical Function in Older Adults: A Systematic Review

## TL;DR

Training older adults with variable-priority cognitive-motor tasks may improve balance and mobility, but its benefits over fixed-priority training are inconsistent.

## Contribution

This systematic review evaluates the effects of variable-priority dual-task training on cognitive and physical outcomes in older adults.

## Key findings

- VPDT is generally linked to improved functional balance and mobility in older adults.
- Evidence for cognitive or psychosocial benefits is limited due to sparse reporting.
- Comparisons with fixed-priority training show inconsistent superiority of VPDT.

## Abstract

What are the main findings?
Variable-priority cognitive-motor dual-task training is generally associated with improvements in functional balance and mobility in older adults, but superiority over fixed-priority dual-task training is inconsistent across trials.Cognitive and psychosocial outcomes are rarely assessed; limited evidence suggests potential benefits for processing speed and fall-related confidence in longer programs.

Variable-priority cognitive-motor dual-task training is generally associated with improvements in functional balance and mobility in older adults, but superiority over fixed-priority dual-task training is inconsistent across trials.

Cognitive and psychosocial outcomes are rarely assessed; limited evidence suggests potential benefits for processing speed and fall-related confidence in longer programs.

What are the implications of the main findings?
Future variable-priority cognitive-motor dual-task training should standardize prioritization instructions and dual-task outcome reporting (including dual-task costs) to enable synthesis and translation.Clinicians may consider variable-priority cognitive-motor dual-task training to train real-world mobility under attentional competition, but should not assume it is universally superior to fixed-priority dual-task training.

Future variable-priority cognitive-motor dual-task training should standardize prioritization instructions and dual-task outcome reporting (including dual-task costs) to enable synthesis and translation.

Clinicians may consider variable-priority cognitive-motor dual-task training to train real-world mobility under attentional competition, but should not assume it is universally superior to fixed-priority dual-task training.

Background: With advancing age, cognitive control and postural-gait regulation decline, while dual-task interference intensifies, leading to restricted mobility and increased fall risk. Variable-priority cognitive-motor dual-task training (VPDT) enhances attentional flexibility and task integration by systematically shifting attentional allocation during training. However, its effects on cognitive and physical function remain unclear. Objective: To review the effects of VPDT on cognitive and physical function in older adults. Method: A comprehensive database search was conducted in the PubMed, Embase, Cochrane, Web of Science, PsycInfo, and CINAHL databases from inception to April 2025, relevant articles were selected, data were extracted using a PICO framework and synthesized narratively. Result: Eight controlled trials (n = 284) were included. Across studies, VPDT was generally associated with improvements in functional balance and mobility outcomes, while between-group differences versus fixed-priority dual-task training (FPDT) were inconsistent. Cognitive outcomes were sparsely reported (only one trial), and psychosocial outcomes were assessed in only a small subset of studies, precluding firm inferences regarding cognitive or psychosocial benefits. Overall risk of bias was predominantly “some concerns,” with two studies rated “high risk,” and overall certainty of evidence ranged from low to moderate due to risk of bias, small samples, and heterogeneity in protocols and outcomes. Conclusions: VPDT may improve physical function in older adults, particularly balance and mobility, but current evidence does not demonstrate a consistent incremental advantage over FPDT. Confidence in comparative effects remains limited due to small sample sizes, risk-of-bias concerns, and heterogeneity in intervention design and outcome measurement.